Grandparental education,parental education and child height: evidence from Hong Kong’s “Children of 1997” birth cohort

PurposeAdult height is the sum of growth during fetal, infancy, childhood, and puberty, controlled by different biological factors. In long-term developed Western populations, height is positively associated with socioeconomic position, but less clearly so in recently developing populations. We aimed to elucidate socioeconomic influences on height at different growth phases.MethodsWe examined the associations of parents' education and grandparents' education with birth weight and height gain z-scores during infancy (birth to <2 years), childhood (2 to <8 years), and puberty (8 to <14 years) adjusted for parents' height using generalized estimating equations in Hong Kong's “Children of 1997” birth cohort (n = 8264).ResultsParents' education, but not grandparents', was positively associated with birth weight (z-score, 0.07; 95% confidence interval [CI] 0.01–0.12 for grade ≥12 compared with grade ≤9) and height gain during infancy (0.11; 95% CI, 0.05–0.18), adjusted for gender, gestational age, initial size, parity, parents' age, parents' birthplace, and parents' height. Conversely, similarly adjusted, grandparents' education, but not parents', was associated with height gain during childhood (0.11; 95% CI, 0.04–0.18).ConclusionsParental education was associated with fetal and infant, but not childhood, linear growth, suggesting the mechanism underlying socioeconomic influences on height at different growth phases may be contextually specific.     

Safety of deep sedation without intubation during surgical abortion in the independent clinic setting

ObjectiveTo establish the safety of deep sedation without intubation delivered by a certified registered nurse anesthetist (CRNA) in an independent outpatient abortion setting.Study designWe performed a review of clinic Quality and Patient Safety Reports, a daily-maintained report of complications at time of all dilation and curettage (D&C) and dilation and evacuation (D&E) procedures performed at an independently operated, urban, high-volume abortion clinic between March 2013 and August 2017. The clinic provided procedures through 23 weeks 6 days gestation to women at low risk for medical or surgical complications, referring high-risk procedures to a nearby hospital. A CRNA provided anesthesia for all deep sedation procedures. We extracted information on gestational age, risk factors, and clinical course for all patients who experienced any anesthesia-related complication.ResultsDuring the study period, the clinic evaluated 10,297 women for surgical abortion, referring 292 high-risk cases and performing 10,005 procedures (9004 D&C and 1001 D&E), most (9405 [94%]) with deep sedation. We documented six anesthesia-related complications; three (0.03%) in D&C procedures (laryngospasm not requiring intubation [n = 2] and respiratory stridor) and three (0.30%) in D&E procedures (laryngospasm requiring intubation, seizure, and hypotension/bradycardia). Only one patient (0.01%) required intubation.ConclusionsAnesthesia-related complications in the setting of deep sedation without intubation during surgical abortion were exceedingly rare, supporting the safety of this form of anesthesia for low-risk patients in an independent community clinic setting.ImplicationsIndependent community clinics, where the majority of abortion procedures are performed within the U.S., can provide safe anesthesia care using deep sedation provided by CRNA professionals. This care delivery model, which includes triaging patient eligibility, reassuringly provides anesthesia as safely as other greater resourced care delivery settings.     

Perceived Importance of Dietary Protein to Prevent Weight Gain: A National Survey among Midlife Women

ObjectiveEvaluate reported use of the practice of “eating more protein” to prevent weight gain among midlife women.DesignCross-sectional national survey.ParticipantsOne thousand eight hundred twenty-four midlife women (40-60 y) from the 9 United States geographic regions, primarily married (71%), white (76%), and well educated; half were premenopausal (49%).OutcomesFrequency of dietary practices to prevent weight gain, Weight Efficacy Lifestyle score, self-reported weight change and body mass index over the past 2 years, and current protein intake.AnalysisLinear regression models determined associations between weight change, protein intake, and reported use of the practice of “eating more protein” to prevent weight gain.ResultsMost women correctly identified good protein sources, and the majority could indicate the daily percent dietary energy recommended from protein. “Eating more protein” to prevent weight gain was reported by 43% of women as a practice to prevent weight gain and was associated with weight loss over a 2-year period and with increased percent energy from protein.Conclusions and ImplicationsReported use of the practice of “eating more protein” was associated with weight loss over 2 years. Education regarding dietary protein requirements may enhance the use of this practice.     

Birth weight,infant growth,and adolescent blood pressure using twin status as an instrumental variable in a Chinese birth cohort: “Children of 1997”

PurposeTo evaluate the credibility of twin status as an instrumental variable for birth weight and infant growth and to obtain less-confounded estimates of the associations of birth weight or infant growth with adolescent blood pressure (BP).MethodsProspective population-based “Children of 1997” birth cohort of all surviving infants born in Hong Kong, China, from April to May 1997 with sex-, age-, and height-specific BP z-score at approximately 11 years (n = 6276) and approximately 13 years (n = 5305).ResultsIn instrumental variable analyses, birth weight-for-gestational age z-score was not associated with z-score for systolic BP (0.01; 95% confidence interval [CI], −0.22 to 0.25) or diastolic BP (0.04; 95% CI, −0.09 to 0.18) at approximately 11 years adjusted for maternal age and migrant status (F = 38.6). Change in weight z-score at 0 to 12 months was not associated with z-score for systolic BP (−0.003; 95% CI, −0.15 to 0.15) or diastolic BP (−0.02; 95% CI, −0.10 to 0.07) at approximately 11 years (F = 54.4). Estimates were similar for BP at approximately 13 years, although the F-statistic was lower.ConclusionsBirth weight and infant growth may make little contribution to adolescent BP. Extending consideration of the effects of early life to other growth periods, such as puberty, on BP might yield public health benefits.     

Measures of success of computerized clinical decision support systems: An overview of systematic reviews

IntroductionAlthough increasing number of clinical decision support systems (CDSSs) were introduced, a lack of rigorous evaluations of information systems (IS) success limits these systems’ usage and diffusion. The purpose of this overview is to identify specific features which are critical to information system success based on the updated DeLone & McLean IS Success Model from published systematic reviews (SRs) over the last 10 years.MethodsThis systematic review was prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.ResultsThere were 39 measures were synthesized from 45 SRs published during 2009–2020 and were classified into 16 categories and 6 dimensions. The most frequently displayed dimension was “net benefit”, which was divided into four categories: “process of care”, “professional competency”, “patient outcomes” and “cost-effectiveness”. Very limited publications summarized evaluation metrics under the remaining five dimensions, excepted “validity” in “system performance” category and “acceptance” in “use behavior” category.ConclusionThe findings of this overview may have meaningful and useful implications to the evaluation of CDSSs. Future research needs to focus on developing a comprehensive evaluation framework through summarizing evaluation metrics on the base of theoretical model, which is critical to CDSSs development, utilization and research. Furthermore, multi-centered, large sample size and long-term follow up studies are required to ensure more reliable evidence on patient outcomes of CDSSs usage.     

Understanding heterogeneity in the effects of birth weight on adult cognition and wages

A large economics literature has shown long term impacts of birth weight on adult outcomes, including IQ and earnings that are often robust to sibling or twin fixed effects. We examine potential mechanisms underlying these effects by incorporating findings from the genetics and neuroscience literatures. We use a sample of siblings combined with an “orchids and dandelions hypothesis”, where the IQ of genetic dandelions is not affected by in utero nutrition variation but genetic orchids thrive under advantageous conditions and wilt in poor conditions. Indeed, using variation in three candidate genes related to neuroplasticity (APOE, BDNF, and COMT), we find substantial heterogeneity in the associations between birth weight and adult outcomes, where part of the population (i.e., “dandelions”) is not affected by birth weight variation. Our results help uncover why birth weight affects adult outcomes.     

Socioeconomic consequences of the 2004 tsunami: Policy implications for natural disaster management

ObjectiveThe objective of the study is to assess the socioeconomic status of the households affected by the tsunami of 2004 & to determine the factors associated with the recovery of household economic status.MethodsThe study was conducted in tsunami-affected areas in Malaysia in 2010–2011. A total of 193 households were included in the survey. Multivariate logistic regression was performed to determine the factors related to the recovery of households' economic status.FindingsAmong 193 households, 37% were in a better condition, 40% were unchanged and 22% had not recovered. It took 2.2 years to get back to pre-disaster economic status. Factors leading to successful household economic recovery were “household resided in Sungai Petani”, “belong to highest income quartile” and “age of household head”. In contrast, “extended family type” and “unemployed household head” reduced the odds of recovery. Households which lost their fishing boats during the tsunami had less chance to recover their previous status.ConclusionThe findings of our study would be useful for policy consideration and planning of post disaster management in order to enhance the recovery of household economic status in the short period.     

Accumulated exposure to rural areas of residence over the life course is associated with overweight and obesity in adulthood: a 25-year prospective cohort study

PurposeThis prospective cohort study investigated whether body mass index (BMI) and weight status in mid-adulthood were predicted by trajectories of urban-rural residence from childhood to adulthood.MethodsParticipants aged 7–15 years in 1985 (n = 8498) were followed up in 2004–2006 (n = 3999, aged 26–36 years) and 2009–2011 (n = 3049, aged 31–41 years). Area of residence (AOR) was classified as urban or rural at each time point. BMI and/or weight status was calculated from self-reported weight and height (2009–2011). We tested which of three life-course models (“accumulation,” “sensitive period,” “mobility”) best explained the AOR-BMI and/or weight status association using a novel life-course modeling framework.ResultsAccumulation and sensitive period models best described the effect of AOR on mid-adulthood BMI and weight status. Those with greater accumulated exposure to rural areas had a higher BMI (β = 0.29 kg/m² per time in a rural area, P = .005) and were more likely obese (relative risk = 1.13 per time in a rural area, P = .002). Living in rural areas at ages 26–30 years was also associated with a higher BMI and obesity in mid-adulthood.ConclusionsGreater cumulative exposure to rurality and exposure during the “sensitive period” of young adulthood is associated with obesity in middle-aged adults. This study highlights the important contribution of context to the development of obesity over the life course.     

Two‐Year Follow‐up of a Randomized Controlled Nutrition Intervention Trial in Very Low‐Birth‐Weight Infants

Background: Very low‐birth‐weight (VLBW) infants are at risk for neurodevelopment impairment. This study assessed the effect of early aggressive parenteral nutrition (PN) on long‐term outcome in VLBW infants. Materials and Methods: Directly after birth, VLBW infants (birth weight <1500 g, n = 142) were randomized to 5 different PN regimes. Controls (n = 46) received glucose and standard‐dose amino acids (AAs; 2.4 g/[kg·d]) from birth onward and pure soybean oil fat emulsion (SOY) on the second day of life. Two intervention groups received glucose, standard‐dose AAs, and lipids from birth onward: SOY (n = 24) or mixed fat emulsion (MIX, n = 25). The 2 other intervention groups received glucose, high‐dose AAs (3.6 g/[kg·d]), and lipids from birth onward: SOY (n = 24) or MIX (n = 23). The primary outcome of this follow‐up study was the composite outcome of “death or major disability” at 2 years corrected age. Secondary outcomes were death, major disabilities, neurodevelopmental scores, and anthropometry. Results: Follow‐up rate was 92% (n = 134). Thirty‐five (26%) infants had died or had a major disability, with no differences between intervention groups and controls. Increased odds for death were observed in the standard‐dose AA‐MIX group (odds ratio, 5.4; 95% confidence interval [CI], 1.1–27.0). Neurodevelopmental scores and incidence of major disabilities did not differ between groups. Growth in the high‐dose AA‐MIX group was enhanced compared with growth in controls at 2 years corrected age (+0.51 [0.01–1.02] weight SDS). Conclusion: This randomized controlled hypothesis‐generating study demonstrated no beneficial effect of early high‐dose AA administration and mixed fat emulsions on survival and neurodevelopmental outcome in VLBW infants, although growth was enhanced.     

Combination and adaptation of two tools to assess parental feeding practices in pre-school children

ObjectiveTo test a combined version of the Child Feeding Questionnaire and the expanded concept of parental control (“covert” and “overt”) among Portuguese preschool children.MethodsThe final questionnaire comprised 38 items and 9 subscales. The translated questionnaire was self-administered to 854 mothers of 4 year-old children from the Generation XXI birth cohort. Maternal and children's weight and height and socio-demographic characteristics were measured. The global goodness of fit was evaluated by confirmatory factor analysis. Cronbach's alpha was used to measure the reliability of subscales. Construct validity was tested for different dimensions.ResultsA 9-factor model was obtained, after excluding five “restriction” items and 1 “overt control” item, with a global goodness of fit (CFI = 0.961, TLI = 0.973, RMSEA = 0.057). Cronbach's alpha ranged from 0.684 to 0.889. Children's body mass index (BMI) was significantly and positively related with “perceived parental weight”, “perceived child's weight” and “concern about child's weight”, and inversely related with “pressure to eat”, supporting the theoretical hypothesis. Maternal BMI was positively related with “perceived parental weight”.ConclusionsOur study confirmed the usefulness of this questionnaire for Portuguese preschool children, and supports the need of reformulating the restriction dimension and keeping separately the overt and covert control dimensions.     

Cross-sectional reporting of previous Cesarean birth was validated using longitudinal linked data

ObjectiveThe aim of this study was to demonstrate the feasibility of using linked health records to assess data quality in population health data.Study Design and SettingReproductive histories of 155,897 women were constructed by longitudinal linkage of the New South Wales (Australia) birth records in 1998–2005, and 127,952 birth and hospital discharge records in 2000–2005 were cross-sectionally linked. History of Cesarean section (CS) derived from the longitudinal linkage (“gold standard”) was used to validate the CS history fields (i.e., “Was the last birth by Cesarean section?” and “Total number of previous Cesarean sections?”) in birth records and to validate “vaginal birth after previous Cesarean (VBAC)” and “maternal care for uterine scar” in hospital records.ResultsThe reporting of CS at last birth was reliable with sensitivity, specificity, positive predictive value (PPV), and negative predictive value all >95% as was the number of previous CS (weighted kappa = 0.97). For the hospital data, sensitivity and PPV were 46% and 99% for VBAC, 92% and 99% for maternal care of uterine scar, and 85% and 99%, respectively, for any prior CS.ConclusionAssessing data quality by record linkage is feasible and can be done more quickly and cheaply than by any traditional validation study.     

Uterine evacuation in the setting of transabdominal cerclage

ObjectivePatients with transabdominal cerclage in place present a management challenge in the setting of undesired pregnancy, pregnancy failure, or pre-viable pregnancy complications. Literature that guides safe surgical technique for uterine evacuation is sparse. This study sought to describe the management and safety profile of dilation and curettage (D&C) and dilation and evacuation (D&E) in patients with transabdominal cerclage.Study designWe used hospital billing records to identify patients with history of transabdominal cerclage placed between January 1998 and August 2019. We subsequently described the patient characteristics and surgical techniques of the procedures among those who underwent uterine evacuation.ResultsOf the 142 patients with an abdominal cerclage placed at our institution, fourteen had subsequent uterine aspiration for a total of 19 procedures over the study period. We describe fifteen D&C procedures in 11 patients between 5- and 12-weeks gestation, and four D&E procedures in three patients between 17- and 19-weeks gestation. Surgeons used osmotic dilators for cervical preparation and standard surgical techniques. There was one minor complication and no major complications. Three patients had procedures other than uterine evacuation.ConclusionsDilation and curettage and D&E are reasonable potential methods of uterine evacuation in women with transabdominal cerclage.Implications statementThis chart review suggests D&C and D&E are reasonable management options in the setting of transabdominal cerclage. Current practice guidelines should reflect the utilization of these procedures as potentially less invasive means of uterine evacuation.     

Early Diet and Later Cancer Risk: Prospective Associations of Dietary Patterns During Critical Periods of Childhood with the GH-IGF Axis,Insulin Resistance and Body Fatness in Younger Adulthood

Early life, adiposity rebound, and puberty represent critical growth periods when food choices could have long-term relevance for cancer risk. We aimed to relate dietary patterns during these periods to the growth hormone-insulin-like-growth-factor (GH-IGF) axis, insulin resistance, and body fatness in adulthood. Data from the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study participants with outcome data at 18–37 years, and ≥2 dietary records during early life (1–2 yr; n = 128), adiposity rebound (4–6 years, n = 179), or puberty (girls 9–14, boys 10–15 yr; n = 213) were used. Dietary patterns at these ages were derived by 1) reduced rank regression (RRR) to explain variation in adult IGF-I, IGF-binding protein-3 (IGFBP-3), homoeostasis model assessment for insulin resistance (HOMA-IR) and fat-mass index; 2) principal component analysis (PCA). Regarding RRR, the patterns “cake/canned fruit/cheese & eggs” (early life), “sweets & dairy” (adiposity rebound) and “high-fat foods” (pubertal boys) were independently associated with higher adult HOMA-IR. Furthermore, the patterns “favorable carbohydrate sources” (early life), “snack & convenience foods” (adiposity rebound), and “traditional & convenience carbohydrates” (pubertal boys) were related to adult IGFBP-3 (P trend < 0.01). PCA identified “healthy” patterns for all periods, but none was associated with the outcomes (P trend > 0.1). In conclusion, dietary patterns during sensitive growth periods may be of long-term relevance for adult insulin resistance and IGFBP-3.     

The Preferred Qualities of Human Immunodeficiency Virus Testing and Self-Testing Among Men Who Have Sex With Men: A Discrete Choice Experiment

ObjectivesHuman immunodeficiency virus self-testing (HIVST) is a promising approach to improve HIV testing coverage. We aimed to understand HIV testing preferences of men who have sex with men (MSM) to optimize HIVST implementation.MethodsDiscrete choice experiments (DCEs) were conducted among HIV-negative MSM living in Australia and aged ≥18 years. Men completed 1 of 2 DCEs: DCETest for preferred qualities of HIV testing (price, speed, window period, test type, and collector of specimen) and DCEKits for preferred qualities of HIVST kits (price, location of access, packaging, and usage instructions). Latent class conditional logit regression was used to explore similarities (or “classes”) in preference behavior.ResultsOverall, the study recruited 1606 men: 62% born in Australia, who had an average age of 36.0 years (SD 11.7), and a self-reported median of 4 (interquartile range 2-8) sexual partners in the last 6 months. The respondents to DCETest was described by 4 classes: “prefer shorter window period” (36%), “prefer self-testing” (27%), “prefer highly accurate tests” (22%), and “prefer low prices” (15%). Respondents to DCEKits were described by 4 classes: “prefer low prices” (48%), “prefer retail access (from pharmacy or online stores)” (29%), “prefer access at sex venues” (15%), and “prefer to buy from healthcare staff” (12%). Preferences varied by when someone migrated to Australia, age, frequency of testing, and number of sexual partners.ConclusionA subset of MSM, particularly infrequent testers, value access to HIVST. Expanding access to HIVST kits through online portals and pharmacies and at sex venues should be considered.     

The “Latina Epidemiologic Paradox”: Contrasting Patterns of Adverse Birth Outcomes in U.S.-Born and Foreign-Born Latinas

BackgroundThe “Latina epidemiologic paradox” postulates that despite socioeconomic disadvantages, Latina mothers have a lower risk for delivering low birth weight (LBW) babies than non-Latina Whites. However, these patterns may be changing over time and may differ depending on the mother's birthplace and legal status in the United States. This study investigates differences in risk for three birth outcomes among Whites, U.S.-born Latinas, and foreign-born Latinas.MethodsWe undertook a cross-sectional study of rates of LBW, preterm, and small-for-gestational-age (SGA) births among 196,617 women delivering live, singleton births in Utah from 2004 to 2007. Each group was compared using logistic regression.ResultsU.S.-born Latinas had a similar or greater risk for all three outcomes when compared with Whites. Foreign-born Latinas had lower risk for preterm birth (odds ratio [OR], 0.85; 95% confidence interval [CI], 0.80–0.90) compared with Whites, but not for LBW and SGA; foreign-born Latinas had a lower risk for LBW (OR, 0.82; 95% CI, 0.74–0.92), preterm birth (OR, 0.81; 95% CI, 0.74–0.89), and SGA (OR, 0.91; 95% CI, 0.83–0.99) compared with U.S.-born Latinas. Among foreign-born Latinas only, there was no difference in risk between documented (i.e., those who had a legal social security number) and undocumented women for LBW, preterm birth, or SGA.ConclusionsThese data support the existence of a variation of the “Latina paradox” among Latinas according to birthplace, where U.S.-born Latinas do not experience better birth outcomes than Whites, but foreign-born Latinas experience better birth outcomes for several endpoints compared with U.S.-born Latinas. Prevention efforts may prove more effective by considering the different composition of risk factors among foreign- and U.S.-born Latina populations.     

Association between parental history of diabetes and the incidence of type 2 diabetes mellitus differs according to the sex of the parent and offspring's body weight: A finding from a Japanese worksite-based cohort study

ObjectiveTo investigate differences in the association of parental history of diabetes with the risk of type 2 diabetes mellitus (T2DM) in the offspring according to the sex of the parent and the offspring's body weight.MethodsA prospective cohort study of 4446 middle-aged non-diabetic Japanese men and women were followed in Aichi Prefecture, central Japan, from 2002 to 2011. Subjects were categorized by their self-reported parental history of diabetes (“no parental history,” “father only,” “mother only,” and “both”). The association of parental history of diabetes and incidence in the offspring was examined according to overweight status adjusted for age, sex, birth weight, smoking, alcohol consumption, physical activity, total energy intake, body mass index, and number of metabolic syndrome components.ResultsDuring follow-up (median 8.9 years), 277 subjects developed T2DM. Parental history of diabetes was positively associated with T2DM incidence. However, stratified analysis by overweight status revealed that only maternal history was associated with increased T2DM incidence in non-overweight subjects (hazard ratio = 2.35, 95% confidence interval: 1.41–3.91). While in overweight subjects, paternal history was significantly associated with higher T2DM incidence (hazard ratio = 1.98, 95% confidence interval: 1.19–3.28).ConclusionsOur results suggest that parental history of diabetes mellitus is associated with the incidence of T2DM in offspring differently according to the sex of the affected parent and the offspring's body weight.     

上海市浦东新区0～3岁低出生体重儿的生长轨迹研究

目的 了解上海市浦东新区低出生体重儿童0～3岁体格生长状况,并掌握早产低出生体重儿和足月小样儿不同的生长轨迹。方法 选取2014年10月-2016年9月出生并在浦东新区各社区卫生服务中心接受保健管理的387名低出生体重儿为观察组,并在同社区选取同性别同年龄段的386名正常儿童作为对照组,对其0～3岁期间的体重、身长/身高进行对比研究。结果 0～3岁期间,低出生体重儿的体重、身长/身高发育均落后于对照组(P<0.01);随着年龄增长,高危早产儿和低危早产儿的体重、身长/身高均赶超足月小样儿,且有差异统计学意义(P<0.05);高危早产儿和低危早产儿两组间的体重和身长/身高差异无统计学意义(P>0.05);三组低出生体重儿在0～3岁期间整体体重差异有统计学意义(P<0.05),但身高差异无统计学意义(P>0.05);高危早产儿和低危早产儿的体重、身长/身高长速均超过足月小样儿和足月正常儿童。结论 低出生体重儿在0～3岁期间存在追赶性生长;早产低体重儿与足月小样儿呈现不同的生长轨迹,早产低体重儿可能具有更大的生长潜能。     

上海市浦东新区0～3岁低出生体重儿的生长轨迹研究

目的 了解上海市浦东新区低出生体重儿童0～3岁体格生长状况,并掌握早产低出生体重儿和足月小样儿不同的生长轨迹。方法 选取2014年10月-2016年9月出生并在浦东新区各社区卫生服务中心接受保健管理的387名低出生体重儿为观察组,并在同社区选取同性别同年龄段的386名正常儿童作为对照组,对其0～3岁期间的体重、身长/身高进行对比研究。结果 0～3岁期间,低出生体重儿的体重、身长/身高发育均落后于对照组(P<0.01);随着年龄增长,高危早产儿和低危早产儿的体重、身长/身高均赶超足月小样儿,且有差异统计学意义(P<0.05);高危早产儿和低危早产儿两组间的体重和身长/身高差异无统计学意义(P>0.05);三组低出生体重儿在0～3岁期间整体体重差异有统计学意义(P<0.05),但身高差异无统计学意义(P>0.05);高危早产儿和低危早产儿的体重、身长/身高长速均超过足月小样儿和足月正常儿童。结论 低出生体重儿在0～3岁期间存在追赶性生长;早产低体重儿与足月小样儿呈现不同的生长轨迹,早产低体重儿可能具有更大的生长潜能。     

Using Deliberative and Qualitative Methods to Recommend Revisions to the Medicaid Sterilization Waiting Period

BackgroundSterilization is used by one-quarter of women in the United States for contraception and is a preferred birth control method among women with Medicaid. A history of coercive sterilization practices in the United States led to federal regulation of consent for Medicaid sterilization (including a mandated waiting period); this regulation can be a barrier to sterilization in Medicaid-insured women. This study aimed to develop a revised model of Medicaid sterilization policy grounded in the experiences of women impacted by current regulations.MethodsThis prospective study used in-depth interviews with 32 Medicaid-insured women who had obtained or tried to obtain sterilization to elicit recommendations regarding the Medicaid waiting period. Deliberative methods (a planning cell including 20 key community stakeholders) were used to evaluate women's recommendations and propose a revised policy for sterilization under Medicaid.ResultsIn-depth interview data demonstrated that women were often not made aware of the 30-day waiting period during informed consent before sterilization. Once informed about the policy, women described the Medicaid waiting period as “unfair,” because it did not apply to all women. After deliberating women's recommendations to change the policy, key stakeholders came to a consensus around replacing the current waiting period policy with an improved consent process that would acknowledge the problematic history of coercive sterilization. Participants could not endorse removing the waiting period altogether without evidence that the health system had shifted away from coercive sterilization practices.ConclusionsUsing deliberative methods and the recommendations of women with Medicaid insurance, community stakeholders recommended developing a revised Medicaid sterilization consent policy that acknowledged the historical context of this procedure.     

Adherence to the Mediterranean diet and weight status in children: the role of parental feeding practices

Abstract

The study examines Parental Feeding Practices (PFP) in relation to adherence to the Mediterranean Diet (MD) and children’s weight status. It’s a cross-sectional study of 402 parents (68.4% mothers), with children aged 2–12 years. Parents completed the Comprehensive Parental Feeding Questionnaire and the Mediterranean Diet Quality Index for children and adolescents (KIDMED), evaluating children’s adherence to the MD. Logistic regression showed that in children aged 2–<6 years, “emotion regulation/food as reward” and “pressure” decrease MD adherence (OR?=?0.186, p?<?0.0001 and OR?=?0.496, p?=?0.004), and “monitoring” decrease excess body weight (OR?=?0.284, p?=?0.009). In older children (6–12 years), “healthy eating guidance” and “monitoring” increase MD adherence (OR?=?3.262, p?=?0.001 and OR?=?3.147, p?<?0.0001), “child control” decreases MD adherence (OR?=?0.587, p?=?0.049), “pressure” decrease excess body weight (OR?=?0.495, p?<?0.0001) and “restriction” increase excess body weight (OR?=?1.784, p?=?0.015). “Healthy eating guidance” and “monitoring” seem to be the best PFP employed, in terms of children’s MD adherence and weight status.